Compositions and methods for reducing cancer stem cell growth

ABSTRACT

A nutritional supplement is described that is useful in combination with radiotherapy to reduce the growth of tumor stem cells. The nutritional supplement includes selenium and fish oil, and has been also found to be effective in reducing negative side effects of concurrent radiotherapy, including inflammation, weight loss, muscle wasting, neutropenia, and loss of cells from the lining of the gut.

This application is a continuation of U.S. patent application Ser. No.16/338,678, filed Apr. 1, 2019, which was nationalized fromInternational Patent Application No. PCT/US2017/054988, filed Oct. 3,2017, which claims priority to U.S. Provisional Application No.62/403,630 filed on Oct. 3, 2016. These and all other referencedextrinsic materials are incorporated herein by reference in theirentirety. Where a definition or use of a term in a reference that isincorporated by reference is inconsistent or contrary to the definitionof that term provided herein, the definition of that term providedherein is deemed to be controlling.

FIELD OF THE INVENTION

The field of the invention is cancer radiotherapy.

BACKGROUND

The following description includes information that may be useful inunderstanding the present invention. It is not an admission that any ofthe information provided herein is prior art or relevant to thepresently claimed invention, or that any publication specifically orimplicitly referenced is prior art.

Radiotherapy and chemotherapy protocols utilized in the treatment ofcancer can clearly benefit patients, but can be ineffective or lesseffective with some cancers. In addition, both radiotherapy andchemotherapy are associated with significant side effects, includingnausea, weight loss, hair loss, damage to the gastrointestinal tract,and skin irritation.

Attempts have been made to enhance the effectiveness of radiotherapy.For example, gold nanoparticles that have been modified to target tumorcells have been used to enhance radiotherapy (Yang et al, ACS Nano,2014, 8(9):8992-9002). All publications herein are incorporated byreference to the same extent as if each individual publication or patentapplication were specifically and individually indicated to beincorporated by reference. Where a definition or use of a term in anincorporated reference is inconsistent or contrary to the definition ofthat term provided herein, the definition of that term provided hereinapplies and the definition of that term in the reference does not apply.Similarly, COX-2 inhibitors have been used to selectively sensitizetumor cells to the effects of radiation (Choy and Milas, J. Natl CancerInst (2003) 95(19):1140-1452). Such approaches, however, can have issueswith selectivity and may not be effective against all tumor types. Todate attempts to reduce the side effects of radiotherapy are primarilydirected to partitioning the total radiation dose into a number ofsmaller radiation doses (leaving time in between to allow for recovery),targeting of tumor using shielding, and identification of the boundariesof the tumor and localization of radiotherapy to that site.Unfortunately, such approaches can fail to adequately treat all of thetumor cells.

Attempts have also been made to enhance the effects of chemotherapy.Some studies have suggested that consumption of fish oil can improveresults from chemotherapy, however other research has suggested thatfish oil can interfere (Daenen et al, JAMA Oncol (2015) 1(3):350-358).Formulation of chemotherapeutic agents as nanoparticles has also beenattempted (Xu et al, Coll. Surf. B: Biointerfaces (2006) 48(1):50-57).It is unclear, however, if all chemotherapeutic drugs are suitable forsuch reformulation. Codelivery of chemotherapeutic drugs with siRNAdesigned to interfere with multi-drug resistance has also been explored.Such siRNAs, however, are sequence specific and may not be suitable forsome tumors.

Mitigation of the side effects of chemotherapy are generally directed atproviding symptomatic relief. For example, antiemetics can be used toreduce nausea, along with diet modification and eating small, frequentmeals that avoid certain foods. Unfortunately, such approaches are notalways effective. In some instances, chemotherapeutic agents areselected to have reduced toxicity in order to reduce side effects,however such agents may also have reduced effectiveness against tumorcells.

Thus, there is still a need for safe and effective compositions andmethods to enhance the effectiveness and/or reduce the side effects ofcancer radiotherapy.

SUMMARY OF THE INVENTION

The inventive subject matter provides apparatus, systems and methods inwhich a nutritional supplement as shown in Table 1 is used incombination with radiotherapy to treat a tumor and/or reduce oreliminate negative side effects of cancer radiotherapy.

One embodiment of the inventive concept is a method of treating a tumorthat includes applying a radiotherapy protocol to a patient in need oftreatment and providing the patient with a nutritional supplementformulated as listed in Table 1, where the nutritional supplement isprovided in an amount that provides a synergistic effect in reducingtumor volume or weight. In some embodiments the method of claim 1,wherein the nutritional supplement is provided to the patient prior tothe initiation of radiotherapy.

Another embodiment of the inventive concept is a method of reducing sideeffects of radiotherapy that includes applying a radiotherapy protocolto a patient in need of treatment and providing the patient with anutritional supplement formulated as shown in Table 1, in an amount thatis effective to reduce a side effect of the radiotherapy protocol. Insome embodiments the nutritional supplement is provided to the patientprior to the initiation of radiotherapy.

Another embodiment of the inventive concept is a method of modulatinggene expression in a tumor by providing a nutritional supplementformulated as shown in Table 1 to a tumor or an animal having a tumor,where the nutritional supplement comprises a plurality of components asand is provided in an amount sufficient to modulate expression of a geneof the tumor. The nutritional supplement can be provided prior to theinitiation of a radiotherapy protocol and/or during the application ofradiotherapy. In some embodiments the gene encodes for an angiogenesisfactor. In other embodiments the gene encodes for an apoptosis factor.

Another embodiment of the inventive concept is a method of reducingmetastasis from a tumor by providing a patient having a metastatic tumorwith a nutritional supplement formulated as in Table 1, where thenutritional supplement is provided in an amount to reduce metastaticactivity of the tumor. The nutritional supplement can be provided priorto and/or concurrently with radiotherapy.

Another embodiment of the inventive concept is a method of reducingangiogenesis in a tumor by providing a patient having a tumor with anutritional supplement formulated as shown in Table 1, where thenutritional supplement is provided in an amount to reduce an angiogenicactivity of the tumor. The nutritional supplement can be provided priorto or concurrently with radiotherapy.

Another embodiment of the inventive concept is a method of reducinggrowth of a cancer stem cell by providing a patient having a tumor thatincludes the cancer stem cell with a nutritional supplement formulatedas in Table 1, where the nutritional supplement is provided in an amountto reduce growth of the cancer stem cell. The nutritional supplement canbe provided prior to or concurrently with radiotherapy.

Various objects, features, aspects and advantages of the inventivesubject matter will become more apparent from the following detaileddescription of preferred embodiments, along with the accompanyingdrawing figures in which like numerals represent like components.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1: FIG. 1 depicts a typical treatment protocol, where nutritionalsupplementation is provided starting either 7 days prior toimplementation of radiotherapy or simultaneously with tumor cellimplantation. In this study mice were sacrificed 21 days after tumorcell implantation.

FIGS. 2A and 2B: FIG. 2A shows changes in body weight observed during atreatment protocol as in FIG. 1. FIG. 2B provides a histogram of resultsfrom a similar study.

FIGS. 3A to 3D: FIGS. 3A to 3D show synergistic effects observed ontumor volume and weight in mice treated with radiotherapy and anutritional supplement of the inventive concept. FIG. 3A shows tumorvolume over 21 days. FIG. 3B shows tumor volume on days 7 to 11. FIG. 3Cshows tumor weight following different treatment regimes. Statisticallysignificant differences are indicated (* to ***). FIG. 3D providesphotographs of tumors excised from mice following treatment withdifferent regimes.

FIGS. 4A to 4E: FIGS. 4A to 4E show the degree of common radiotherapyside effects related to muscle mass and organ weight in mice treatedwith radiotherapy alone, a nutritional supplement of the inventiveconcept, and combined therapy. Statistically significant differences areindicated (* to ***). FIG. 4A shows the effect of treatment usingradiotherapy, a nutritional supplement of the inventive concept, andcombined treatment on gastrocnemius muscle mass 21 days after tumor cellinjection. FIG. 4B shows the effect of treatment using radiotherapy, anutritional supplement of the inventive concept, and combined treatmenton soleus muscle mass 21 days after tumor cell injection. FIG. 4C showsthe effect of treatment using radiotherapy, a nutritional supplement ofthe inventive concept, and combined treatment on lung (inclusive ofmetastatic tumor) weight 21 days after tumor cell injection. FIG. 4Dshows the effect of treatment using radiotherapy, a nutritionalsupplement of the inventive concept, and combined treatment on liver(inclusive of metastatic tumor) weight 21 days after tumor cellinjection. FIG. 4E shows the effect of treatment using radiotherapy, anutritional supplement of the inventive concept, and combined treatmenton spleen (inclusive of metastatic tumor) weight 21 days after tumorcell injection.

FIGS. 5A to 5G: FIGS. 5A to 5G show the degree of common radiotherapyside effects related to various blood cell populations in mice treatedwith radiotherapy alone, a nutritional supplement of the inventiveconcept, and combined therapy. Statistically significant differences areindicated (* to ***). FIG. 5A shows the effect of treatment usingradiotherapy, a nutritional supplement of the inventive concept, andcombined treatment on red blood cell count 21 days after tumor cellinjection. FIG. 5B shows the effect of treatment using radiotherapy, anutritional supplement of the inventive concept, and combined treatmenton granulocyte count 21 days after tumor cell injection. FIG. 5C showsthe effect of treatment using radiotherapy, a nutritional supplement ofthe inventive concept, and combined treatment on platelet count 21 daysafter tumor cell injection. FIG. 5D shows the effect of treatment usingradiotherapy, a nutritional supplement of the inventive concept, andcombined treatment on white blood cell count 21 days after tumor cellinjection. FIG. 5E shows the effect of treatment using radiotherapy, anutritional supplement of the inventive concept, and combined treatmenton lymphocyte count 21 days after tumor cell injection. FIG. 5F showsthe effect of treatment using radiotherapy, a nutritional supplement ofthe inventive concept, and combined treatment on granulocyte count 21days after tumor cell injection. FIG. 5G shows the effect of treatmentusing radiotherapy, a nutritional supplement of the inventive concept,and combined treatment on neutrophil/lymphocyte percentage ratio 21 daysafter tumor cell injection.

FIGS. 6A to 6G: FIGS. 6A to 6G show the degree of common radiotherapyside effects related to serum biochemistry, kidney function, and liverfunction in mice treated with radiotherapy alone or radiotherapy, anutritional supplement of the inventive concept, and combined therapy.Statistically significant differences are indicated (* to ***). FIG. 6Ashows the effect of treatment using radiotherapy, a nutritionalsupplement of the inventive concept, and combined treatment on serumalbumin 21 days after tumor cell injection. FIG. 6B shows the effect oftreatment using radiotherapy, a nutritional supplement of the inventiveconcept, and combined treatment on serum creatinine 21 days after tumorcell injection. FIG. 6C shows the effect of treatment usingradiotherapy, a nutritional supplement of the inventive concept, andcombined treatment on blood urea nitrogen 21 days after tumor cellinjection. FIG. 6D shows the effect of treatment using radiotherapy, anutritional supplement of the inventive concept, and combined treatmenton total bilirubin 21 days after tumor cell injection. FIG. 6E shows theeffect of treatment using radiotherapy, a nutritional supplement of theinventive concept, and combined treatment on serum glutamic oxaloacetictransaminase 21 days after tumor cell injection. FIG. 6F shows theeffect of treatment using radiotherapy, a nutritional supplement of theinventive concept, and combined treatment on serum glutamic-pyruvictransaminase 21 days after tumor cell injection. FIG. 6G shows theeffect of treatment using radiotherapy, a nutritional supplement of theinventive concept, and combined treatment on serum glucose 21 days aftertumor cell injection.

FIGS. 7A and 7B: FIGS. 7A and 7B show the effect of treatment with anutritional supplement of the inventive concept on inflammation that isassociated with tumor growth and with radiotherapy. Mice were treatedwith radiotherapy alone, a nutritional supplement of the inventiveconcept, or combined therapy. Statistically significant differences areindicated (* to ***). FIG. 7A shows the effect of treatment usingradiotherapy, a nutritional supplement of the inventive concept, andcombined treatment on serum IL-6 21 days after tumor cell injection.

FIG. 7B: shows the effect of treatment using radiotherapy, a nutritionalsupplement of the inventive concept, and combined treatment on serumIL-1β21 days after tumor cell injection.

FIGS. 8A to 8G: FIGS. 8A to 8G show the effect of treatment with anutritional supplement of the inventive concept on gene expression intissue and in tumor cells. Mice were treated with radiotherapy alone, anutritional supplement of the inventive concept, or combined therapy.Statistically significant differences are indicated (* to ***). FIG. 8Ashows the effect of treatment using radiotherapy, a nutritionalsupplement of the inventive concept, and combined treatment onexpression of the VEGF gene in an implanted tumor 21 days after tumorcell injection. FIG. 8B shows the effect of treatment usingradiotherapy, a nutritional supplement of the inventive concept, andcombined treatment on expression of the BAX gene in an implanted tumor21 days after tumor cell injection. FIG. 8C shows the effect oftreatment using radiotherapy, a nutritional supplement of the inventiveconcept, and combined treatment on expression of the Bcl-2 gene in animplanted tumor 21 days after tumor cell injection. FIG. 8D shows theeffect of treatment using radiotherapy, a nutritional supplement of theinventive concept, and combined treatment on expression of the caspase 3gene in an implanted tumor 21 days after tumor cell injection. FIG. 8Eshows the effect of treatment using radiotherapy, a nutritionalsupplement of the inventive concept, and combined treatment onexpression of the BAX gene in lung 21 days after tumor cell injection.FIG. 8F shows the effect of treatment using radiotherapy, a nutritionalsupplement of the inventive concept, and combined treatment onexpression of the Bcl-2 gene in lung 21 days after tumor cell injection.FIG. 8G shows the effect of treatment using radiotherapy, a nutritionalsupplement of the inventive concept, and combined treatment onexpression of the caspase 3 gene in lung 21 days after tumor cellinjection.

FIG. 9: FIG. 9 depicts an alternative treatment/study protocol. FIG. 9depicts a treatment/study protocol in which mice receive radiotherapy ondays 8, 10, and 12, with nutritional supplementation beginning with theinitiation of radiotherapy. Mice are sacrificed at day 14 or at day 24following implantation of tumor cells.

FIGS. 10A to 10C: FIGS. 10A to 10C show results of serum albumin andblood cell population studies performed on mice treated with theprotocol shown in FIG. 9. Statistically significant differences areindicated (* to ***). FIG. 10A shows serum albumin concentration at 14days and 24 days following tumor cell implantation in mice treated asshown in FIG. 9. FIG. 10B shows lymphocyte counts at 14 days and 24 daysfollowing tumor cell implantation in mice treated as shown in FIG. 9.FIG. 10C shows N/L Ratios at 14 days and 24 days following tumor cellimplantation in mice treated as shown in FIG. 9.

FIGS. 11A to 11D: FIGS. 11A to 11D show results of studies of expressionof tumor markers and studies of tumor metastatis performed on micetreated with the protocol shown in FIG. 9. FIG. 11A shows the results ofimmunofluorescence studies of VEGF expression within a tumor mass 24days following tumor cell implantation in mice treated as shown in FIG.9. FITC represents VEGF-specific staining. FIG. 11B shows the results ofimmunofluorescence studies of VEGF expression within the lung(metastasis) 24 days following tumor cell implantation in mice treatedas shown in FIG. 9. FITC represents VEGF-specific staining. FIG. 11Dshows the results of immunofluorescence studies of EGFR expressionwithin the tumor mass 24 days following tumor cell implantation in micetreated as shown in FIG. 9. FITC represents EGFR-specific staining inmice treated as shown in FIG. 9. FITC represents CD31-specific staining.

FIG. 12: FIG. 12 shows results of studies of cancer stem celldistribution performed on mice treated with the protocol shown in FIG.9. Immunofluorescence was used to visualize CD31 (a cancer stem cellmarker) expression within the tumor mass and in lung tissue (metastasis)24 days following tumor cell implantation.

FIG. 13: FIG. 13 shows results of studies of the degree of hypoxia inprimary and metastatic tumor sites performed on mice treated with theprotocol shown in FIG. 9. Immunofluorescence was used to visualizeH1F1-α (a hypoxia marker) expression within the tumor mass and in lungtissue (metastasis) 24 days following tumor cell implantation in micetreated as shown in FIG. 9. FITC represents H1F1-α-specific staining.

FIG. 14: FIG. 14 shows results of qPCR studies of apoptosis markerexpression in tumors, performed on mice treated with the protocol shownin FIG. 9. Studies were performed 24 days after tumor cell implantation.

FIG. 15: FIG. 15 depicts an alternative treatment/study protocol. FIG.15 depicts a treatment/study protocol in which mice receive radiotherapyon days 8, 10, and 12, with nutritional supplementation provided priorto tumor cell implantation, at the time of tumor cell implantation, orat the initiation of radiotherapy. Mice are sacrificed at day 21following implantation of tumor cells.

FIG. 16: FIG. 16 shows photomicrographs of gut cellular architecture inmice treated with the protocol shown in FIG. 15.

FIGS. 17A to 17F: FIGS. 17A to 17F depicts results from studies of geneexpression in tumor cells of mice treated with the protocol shown inFIG. 15. Statistically significant differences are indicated (* to ***).FIG. 17A shows the effect of treatment using radiotherapy, a nutritionalsupplement of the inventive concept, and combined treatment onexpression of the VEGF gene 21 days after tumor cell injection. FIG. 17Bshows the effect of treatment using radiotherapy, a nutritionalsupplement of the inventive concept, and combined treatment onexpression of the BAX gene 21 days after tumor cell injection. FIG. 17Cshows the effect of treatment using radiotherapy, a nutritionalsupplement of the inventive concept, and combined treatment onexpression of the Bcl-2 gene 21 days after tumor cell injection. FIG.17D shows the effect of treatment using radiotherapy, a nutritionalsupplement of the inventive concept, and combined treatment onexpression of the Caspase 3 gene 21 days after tumor cell injection.FIG. 17E shows the effect of treatment using radiotherapy, a nutritionalsupplement of the inventive concept, and combined treatment onexpression of the Bcl-2 gene 21 days in lung (i.e. metastasis) aftertumor cell injection. FIG. 17F shows the effect of treatment usingradiotherapy, a nutritional supplement of the inventive concept, andcombined treatment on expression of the Caspase 3 gene 21 days in lung(i.e. metastasis) after tumor cell injection.

FIG. 18: FIG. 18 depicts an alternative treatment/study protocol. FIG.18 depicts a treatment/study protocol in which mice receive radiotherapyon days 8, 10, and 12, with nutritional supplementation provided for 7days prior to tumor cell implantation. Mice are sacrificed at day 24following implantation of tumor cells.

FIGS. 19A and 19B: FIGS. 19A and 19B shows the results of studies ofloss of body mass and muscle mass in mice treated with the protocolshown in FIG. 18. Statistically significant differences are indicated (*to ***). FIG. 19A shows the effect of treatment with a nutritionalsupplement of the inventive concept on body mass in mice receivingrepeated radiotherapy following tumor cell implantation using theprotocol shown in FIG. 18. FIG. 19B shows the effect of treatment usingradiotherapy, a nutritional supplement of the inventive concept, andcombined treatment on gastrocnemius muscle mass 21 days after tumor cellinjection using the protocol shown in FIG. 18.

FIG. 20: FIG. 20 depicts an alternative treatment/study protocol. FIG.20 depicts a treatment/study protocol in which mice receive radiotherapyon days 8, 10, and 12, with nutritional supplementation provided for 7days prior to, the day of, or 8 days after tumor cell implantation. Miceare sacrificed at day 21 following implantation of tumor cells.

FIG. 21: FIG. 21 shows the effect of treatment with a nutritionalsupplement on body mass in mice receiving repeated radiotherapyfollowing tumor cell implantation using the protocol shown in FIG. 20.Statistically significant differences are indicated (* to ***).

FIG. 22: FIG. 22 shows changes in tumor volume over time on repeatedradiotherapy in combination with treatment with a nutritional supplementof the inventive concept in mice treated as in the protocol shown inFIG. 20.

FIGS. 23A and 23B: FIGS. 23A and 23B show the effect of the treatmentprotocol shown in FIG. 20 on serum concentration levels ofpro-inflammatory cytokines in mice undergoing repeated radiotherapytreatments. FIG. 23A shows the effect of treatment using repeatedradiotherapy, a nutritional supplement of the inventive concept, andcombined treatment on serum TNF-α 21 days after tumor cell injection inmice treated using the protocol shown in FIG. 20. FIG. 23B shows theeffect of treatment using repeated radiotherapy, a nutritionalsupplement of the inventive concept, and combined treatment on serumIL-6 21 days after tumor cell injection in mice treated using theprotocol shown in FIG. 20.

DETAILED DESCRIPTION

The following description includes information that may be useful inunderstanding the present invention. It is not an admission that any ofthe information provided herein is prior art or relevant to thepresently claimed invention, or that any publication specifically orimplicitly referenced is prior art.

The inventive subject matter provides compositions and methods in whicha nutritional supplement is used in combination with radiotherapy.Combination therapy with radiation and a nutritional supplement of theinventive concept surprisingly provides a significant synergistic effectin reduction of tumor size. In addition, side effects of radiotherapy(e.g. neutropenia, loss of body mass, loss of muscle mass, inflammation,damage to acyl cells of the gastrointestinal tract, etc.) are mitigatedand expression of genes related to angiogenesis, pro-inflammatorycytokines, and apoptosis are modulated. In addition, metastasis isprevented and the growth and spread of cancer stem cells is reduced. TheInventors contemplate that similar benefits can be found in cotherapywith anti-cancer immunotherapy agents and a nutritional supplement ofthe inventive concept.

One should appreciate that the disclosed techniques provide manyadvantageous technical effects including enhancing the effectiveness ofcurrent radiotherapeutic protocols used in the treatment of cancer whilereducing the side effects associated with these approaches.

The following discussion provides many example embodiments of theinventive subject matter. Although each embodiment represents a singlecombination of inventive elements, the inventive subject matter isconsidered to include all possible combinations of the disclosedelements. Thus if one embodiment comprises elements A, B, and C, and asecond embodiment comprises elements B and D, then the inventive subjectmatter is also considered to include other remaining combinations of A,B, C, or D, even if not explicitly disclosed.

In some embodiments, the numbers expressing quantities of ingredients,properties such as concentration, reaction conditions, and so forth,used to describe and claim certain embodiments of the invention are tobe understood as being modified in some instances by the term “about.”Accordingly, in some embodiments, the numerical parameters set forth inthe written description and attached claims are approximations that canvary depending upon the desired properties sought to be obtained by aparticular embodiment. In some embodiments, the numerical parametersshould be construed in light of the number of reported significantdigits and by applying ordinary rounding techniques. Notwithstandingthat the numerical ranges and parameters setting forth the broad scopeof some embodiments of the invention are approximations, the numericalvalues set forth in the specific examples are reported as precisely aspracticable. The numerical values presented in some embodiments of theinvention may contain certain errors necessarily resulting from thestandard deviation found in their respective testing measurements.

In one embodiment of the inventive concept, a nutritional supplementcomposition of the inventive concept, such as shown in Table 1, isprovided to improve the results of radiotherapy.

TABLE 1 Component Minimum Maximum Unit Maltodextrin 10000 50000 mg WheyProtein Isolate 5000 60000 mg Whey Protein Concentrate 1000 50000 mgFructooligosaccharides/Inulin 40 15000 mg Granulated Honey 1000 9000 mgOat Fiber 500 15000 mg Natural French Vanilla Flavor 500 20000 mg SoyProtein 500 50000 mg Brownulated Powdered Brown Sugar 500 10000 mgNatural Vanilla Masking Flavor 500 5000 mg Lecithin 200 10000 mg Milk,Non-fat 50 5000 mg Rice Protein Powder 50 5000 mg Calcium Caseinate 502000 mg Oils Flax Seed Oil 100 7000 mg Canola Oil 100 7000 mg Borage Oil100 7000 mg Olive Oil 100 7000 mg Fish Oil 150 5000 mg Lemon Oil 1001000 mg Orange Oil 50 1000 mg Mixed Tocopherols 0.5 200 mgVitamins/Minerals Potassium Phosphate 200 1500 mg Calcium Carbonate 1005000 mg Choline Bitartrate 150 2500 mg Sodium Chloride 100 2000 mgCalcium Phosphate 100 2000 mg Ascorbic Acid 50 3000 mg PotassiumChloride 50 2000 mg Magnesium Oxide 50 500 mg Selenium Yeast 30 4000 mcgChromium Yeast 30 3000 mcg Molybdenum Yeast 30 2000 mcg Inositol 10 5000mg Zinc Sulfate 5 200 mg Vitamin E 5 2000 IU Niacinamide 5 500 mg FerricOrthophosphate 3 100 mg Calcium Pantothenate 3 200 mg Manganese Sulfate3 100 mg Beta Carotene 1 100 mg Copper Gluconate 1 15 mg Vitamin D3 255000 IU Vitamin K2 2 1000 mcg Pyridoxine 0.5 200 mg Potassium Iodide 0.51500 mg Riboflavin 0.5 1000 mg Thiamine 0.5 2500 mg Vitamin K1 1 500 mcgVitamin A Acetate 500 100000 IU Folic Acid 100 10000 mcg d-Biotin 1010000 mcg Vitamin B12 1 3000 mcg Amino Acids L-Carnitine 300 30000 mgL-Glutamine 500 60000 mg L-Arginine Base 500 30000 mg Taurine 50 2000 mgL-Lysine 50 2000 mg Alpha Lipoic Acid 10 1000 mg Resveratrol 15 1500 mgCo-Enzyme Q10 10 5000 mg Glycine 5 1000 mg Proline 5 1000 mg BacterialCultures Lact. Acidophilus (app. 10 billion total) 2 500 mg BifidoBifidium (app. 10 billion total) 2 500 mg Lac. Bulgaricus (app. 10billion total) 2 500 mg Bifido Longum (app. 10 billion total) 2 500 mgStrep. Thermophilus (app. 10 billion total) 2 500 mg Enzymes Papain 5100 mg Pepsin 5 100 mg Lipase 5 100 mg Bromelain 5 100 mg Pancreatin 0.5100 mg Lactase 1 100 mg Betaine 3 100 mg Plant Products Pineapple JuicePowder 2 500 mg Papaya Fruit Powder 2 500 mg Quercetin 30 3000 mg EGCG25 600 mg OPC 15 500 mg Anthocyanins 15 5000 mg Ellagic Acid 10 300 mgAstaxanthin 2 90 mg Fucoidan 20 1500 mg Mushroom Preparation Cordyceps 56000 mg Ganoderma Lucidum 15 10000 mg Shiitake 40 15000 mg Maitake 3015000 mg Turkey Tail 30 15000 mg

The composition shown in Table 1 includes components that have variousphysiological and biochemical effects, including anti-inflammatoryactivity, lowering of blood glucose levels, lowering of cholesterol, andanti-tumor activity. Other components provide supplementation ofnecessary vitamins, minerals, and amino acids at elevated levels. Othercomponents (e.g. enzymes, lecithin) serve to aid in digestion andabsorption of components of the composition when consumed. Thecombination of these complementary activities provides a synergisticeffect that exceeds the simple additive effect of individual components.It should be appreciated that the composition shown in Table 1 alsoincludes certain flavorants (e.g. brown sugar, honey, vanilla flavorand/or masking agent) that serve to improve palatability and acceptance.Certain components (e.g. honey, brown sugar, milk, rice protein, casein)can provide both flavor and caloric energy. The Inventor has found thatthe combination of flavorants described above is effective in providingcompliance with consumption of the nutritional supplement in effectiveamounts. In some embodiments such flavorants can be excluded from theformulation without negatively impacting the effectiveness of thenutritional supplement, thereby providing a functional nutritionalsupplement that includes only essential components. It should beappreciated that components of a nutritional supplement of the inventiveconcept can be provided as powders, granules, liquids, suspensions,and/or emulsions. In a preferred embodiments component of thenutritional supplement are provided as powders and/or granules.Similarly, in preferred embodiments of the inventive concepts componentsof the nutritional supplement are provided in relative amounts asindicated in Table 1. In some embodiments the components of thenutritional supplement are provided as a single, mixed formulation. Inother embodiments components of the nutritional supplement can beprovided as a kit or similar assembly containing different components ofthe formulation segregated or packaged separately (for example, toprovide different storage conditions conducive to component stability).

It should be appreciated that oils found in the formulation (e.g. FlaxSeed Oil, Canola Oil, Borage Oil, Olive Oil, Fish Oil, Pure Lemon Oil,Pure Orange Oil, Mixed Tocopherols) are at least consumer grade, andpreferably highly purified (>95% pure). It should also be appreciatedthat mineral components (e.g. potassium, calcium, sodium, magnesiumiron, manganese) can be provided as any safe and absorbable salt (e.g. ahalide salt, phosphate salt, carbonate salt, sulfate salt), oxide, ororganic complex (e.g. gluconate). It should also be appreciated thatcertain metals (e.g. chromium, molybdenum, selenium) are supplied in theform of a yeast component, which can include provision as ayeast-containing powder or suspension and/or as a complex with a peptideor amino acid as a result of metabolism of such metals by yeast.Similarly, it should be appreciated that preparation of variousnon-yeast fungi (e.g. Cordyceps, Ganoderma Lucidum, Shiitake, Maitake,Turkey Tail) can include powdered or granular preparation derived fromdried/lyophilized fruiting bodies of such fungi.

A nutritional supplement of the inventive concept can be provided inamounts ranging from about 1 mg/kg body weight to about 100 g/kg body asa unit dose. Such a unit dose can be provided on a schedule ranging from4 times a day to one time per week. The nutritional supplement can beprovided as one or more pills or capsules. Alternatively, thenutritional supplement can be provided as a powder, granular, and/orliquid formulation that is added to a food or a beverage prior toconsumption. In some embodiments the nutritional supplement can beprovided as a food item, such as a food or candy bar. In otherembodiments the nutritional supplement can be provided as a solution,suspension, or beverage that is suitable for oral consumption and/orprovision by tube feeding.

It should be appreciated that packaging that excludes light, moisture,and/or oxygen can be used to extend the shelf life of the nutritionalsupplement. Similarly, a nutritional supplement of the inventive conceptcan be packaged with a hygroscopic agent (such as silica gel), anon-reactive gas (such as N2 or a noble gas), and/or under vacuum inorder to extend shelf life. Such packaging can, for example, provide anutritional supplement of the inventive concept in single unit doses andadditionally provide directions for preparation and/or dosing frequency.

In studies to determine the effect of combined radiotherapy andtreatment with a nutritional supplement of the inventive concept micecarrying human tumor cells (following transplantation into nude mice)were treated with 1 gram per day of the nutritional supplement,radiotherapy, or 1 gram per day of the nutritional supplement andchemotherapy. The mice were weighed during treatment to characterizeside effects such as nausea and loss of appetite. In some studies bloodsamples were taken to determine values for certain serum and cellularcomponents. After several weeks the mice were sacrificed and tumor (and,in some cases, certain muscles and organs) characterized. For example,tumor volume was determined and the impact of therapy on organ andmuscle volume was determined. The degree of neutropenia was alsocharacterized. A typical set of test groups is shown in Table 2.

TABLE 2 Sacrifice (21^(st) day) 1 C Control N = 6 2 T Tumor N = 6 3 PTNTumor + Nutritional Supplement (−7 day start) N = 6 4 TN Tumor +Nutritional Supplement (0 day start) N = 6 5 TR Tumor + Radiotherapy (3Gy × 3) N = 6 6 PTRN Tumor + Radiotherapy (3 Gy × 3) + N = 6 NutritionalSupplement (−7 day start) 7 TRN Tumor + Radiotherapy (3 Gy × 3) + N = 6Nutritional Supplement (8 day start)A typical treatment schedule is depicted schematically in FIG. 1. Inthis treatment protocol nutritional supplementation is provided startingeither 7 days prior to implementation of radiotherapy or simultaneouslywith tumor cell implantation. Mice were sacrificed 21 days after tumorcell implantation.

Results of body weight studies resulting from such a protocol are shownin FIGS. 2A and 2B. As shown, mice receiving both radiotherapy and anutritional supplement of the inventive concept gained weight at asignificantly greater rate than those receiving only radiotherapy,indicating a reduction in undesirable side effects normally associatedwith this treatment mode.

FIGS. 3A to 3D show typical synergistic effects on tumor volume andweight of co-treatment with radiotherapy and a nutritional supplement ofthe inventive concept. FIG. 3A shows the effect of various treatmentprotocols on tumor volume over the course of 3 weeks, with FIG. 3Bproviding a scaled view of the effect over the initial 11 days. Asshown, treatment with the nutritional supplement alone provides anapproximately 60% reduction in tumor volume. Treatment with radiationalone provides a similar reduction in tumor volume. In the absence of asynergistic effect one would therefore anticipate a reduction in tumorvolume to approximately 25% of that of the untreated tumor.Surprisingly, what is observed is a greater than 90% reduction in tumorvolume to approximately 7% of the untreated tumor-indicative of asignificant synergistic effect.

Side effects of radiotherapy go beyond loss of appetite and weight loss,and can include damage to internal organs, loss of muscle mass, anemia,neutropenia, reduction in kidney function, etc. To determine theprotective effects of nutritional supplement/radiotherapy cotherapy inregard to such side effects on muscle mass and organ weight of treatedmice were also characterized following therapy. The results are shown inFIGS. 4A to 4E. Similarly, the effects of this cotherapy on variousblood cell populations are shown in FIGS. 5A to 5G. The effects ofradiotherapy cotherapy with a nutritional supplement of the inventiveconcept on various serum biochemistry markers, which provide informationregarding kidney function, liver function, and/or nutritional status areshown in FIGS. 6A to 6G. As shown, nutritional supplement of theinventive concept is effective in reducing the negative impact ofradiotherapy.

The growth and spread of tumors are associated with inflammation, as isthe application of radiotherapy. Surprisingly, Inventors have found thatcotreatment with a nutritional supplement of the inventive concept iseffective in reducing the concentration of pro-inflammatory cytokines,indicating that such co-treatment is effective in reducing inflammationassociated with tumors, and with radiotherapy of tumors. The effects ofnutritional supplement of the inventive concept on serum concentrationsof pro-inflammatory cytokines is shown in FIGS. 7A and 7B, and showmarked reductions in pro-inflammatory cytokines.

Surprisingly, Inventors have also found that treatment with nutritionalsupplement of the inventive concept can modify gene expression in tumorcells in vivo, and can provide a synergistic effect to such changes ingene expression resulting from radiotherapy. In some embodiments thegenes are related to cytokines and/or are related to apoptosis. Examplesof the effect of radiotherapy, treatment with nutritional supplement ofthe inventive concept, and cotherapy on gene expression in implantedtumor cells in vivo are shown in FIG. 8A to 8F. As shown gene expressionis (at least to some extent) normalized in tumor cells of mice sotreated.

Similar studies were performed using modified treatment protocols. Onesuch modified treatment protocol utilizing multiple rounds ofradiotherapy is shown in FIG. 9. Treatment groups derived from theprotocol shown in FIG. 9 are summarized in Table 3.

TABLE 3 Sacrifice Sacrifice (14^(th) day) (24^(th) day) 1 C Control N =6 N = 6 2 T Tumor N = 6 N = 6 3 TN Tumor + Nutritional Supplement N = 6N = 6 4 T3R Tumor + Radiotherapy (×3) N = 6 N = 6 5 T3RN Tumor +Radiotherapy (×3) + N = 6 N = 6 Nutritional Supplement

It should be appreciated that repeated rounds of radiotherapy are knownto have deleterious effects on subject's nutritional status (at least inpart reflected by serum albumin) and to result in suppression ofproduction of various blood cell types. Results from serum albumin andblood cell characterization studies following treatment with nutritionalsupplement of the inventive concept, radiotherapy, and combinednutritional supplement of the inventive concept and radiotherapy usingthe protocol shown in FIG. 9 are shown in FIGS. 10A to 10C. As shown,treatment with the nutritional supplement is effective in normalizingthese parameters, particularly when the nutritional supplement isprovided in combination with radiotherapy.

Surprisingly, treatment with nutritional supplement of the inventiveconcept, radiotherapy, and combined nutritional supplement of theinventive concept and radiotherapy using the protocol shown in FIG. 9also has an impact on both expression of tumor cell markers and tumorcell metastasis. In the following studies the tumor cells selected forimplantation are derived from a lung tumor and have a strong tendency tometastasize to the lung from the implantation site. FIGS. 11A to 11Dshow the results of immunocytochemistry studies of different tissuesfrom mice treated with the protocol shown in FIG. 9. Cell surfacemarkers associated with the tumor cells are notably reduced. It isnotable that nutritional supplement of the inventive concept alone canreduce or even eliminate metastasis.

Treatment with nutritional supplement of the inventive concept,radiotherapy, and combined nutritional supplement of the inventiveconcept and radiotherapy using the protocol shown in FIG. 9 also has animpact on tumor stem cells. In the following studies the tumor cellsselected for implantation are derived from a lung tumor and have astrong tendency to metastasize to the lung from the implantation site.FIG. 12 shows the results of immunocytochemistry studies of differenttissues from mice treated with the protocol shown in FIG. 9.Surprisingly, treatment with nutritional supplement of the inventiveconcept in the absence of radiotherapy reduces or eliminates theoccurrence of cancer stem cells both in the tumor implantation site andat the lung metastatic site, and potentiates the effects of radiotherapyin combined therapy.

Treatment with nutritional supplement of the inventive concept,radiotherapy, and combined nutritional supplement of the inventiveconcept and radiotherapy using the protocol shown in FIG. 9 also has animpact on hypoxia often found in or among tumor cells. In the followingstudies the tumor cells selected for implantation are derived from alung tumor and have a strong tendency to metastasize to the lung fromthe implantation site. FIG. 13 shows the results of immunocytochemistrystudies of different tissues from mice treated with the protocol shownin FIG. 9. Surprisingly, treatment with nutritional supplement of theinventive concept in the absence of radiotherapy reduces or eliminatesthe occurrence of hypoxia markers in both in the tumor implantation siteand at the lung metastatic site, and potentiates the effects ofradiotherapy when used in combination.

Treatment with nutritional supplement of the inventive concept,radiotherapy, and combined nutritional supplement of the inventiveconcept and radiotherapy using the protocol shown in FIG. 9 also has animpact on apoptic activity in tumor cells. Results of qPCR studies forexpression of apoptosis markers at 24 days from tumor cell implantationin mice are shown in FIG. 14. Surprisingly, treatment with nutritionalsupplement of the inventive concept both enhances the effect ofradiotherapy and increases expression of apoptosis-related genes in theabsence of radiotherapy.

Another treatment protocol utilizing multiple rounds of radiotherapy isshown in FIG. 15. Treatment groups resulting from the protocol shown inFIG. 15 are shown in Table 4.

TABLE 4 Sacrifice Sacrifice (14^(th) day) (24^(th) day) 1 C Control N =6 N = 6 2 T Tumor N = 6 N = 6 3 TN Tumor + Nutritional Supplement N = 6N = 6 4 T3R Tumor + Radiotherapy (×3) N = 6 N = 6 5 T3RN Tumor +Radiotherapy (×3) + N = 6 N = 6 Nutritional Supplement

In this protocol treatment with the nutritional supplement of theinventive concept was initiated prior to tumor cell implantation, at thetime of tumor cell implantation, and at the initiation of radiotherapy.Such a protocol was used to determine the effect of cotherapy withnutritional supplement of the inventive concept and radiotherapy oncellular structures in the gut of tumor-implanted mice. Loss ofintestinal absorption and the resulting malnutrition are a well knownside effect of radiotherapy, and is thought to be due to the loss ofrapidly replicating brush cells in the gut. FIG. 16 showsphotomicrographs that demonstrate the effect of supplementation ofnutritional supplement of the inventive concept on the cellulararchitecture of the gut during radiotherapy. As shown, supplementationwith the nutritional supplement not only maintains but, surprisingly,can also enhance the intestinal brush border during radiotherapy.

Surprisingly, treatment with nutritional supplement of the inventiveconcept has been found to modify expression of certain genes in tumorcells and lungs if tumor-implanted mice in vivo, both in enhancing theeffects of radiotherapy and when provided without (e.g. prior to)radiotherapy. Results of qPCR studies of gene expression (e.g.angiogenic factor-related, apoptosis-related, etc.) in tumor cells frommice treated by the protocol shown in FIG. 15 are shown in FIGS. 17A to17F. It should be appreciated that FIGS. 17E and 17F show results fromtumor cells that have metastasized from the initial implantation site.As shown, expression of VEGF and Bcl-2 are reduced, while Caspase 3 iselevated. BAX shows a more complex response, being elevated in animalstreated with nutritional supplement of the inventive concept and theelevation suppressed when used in combination with radiotherapy.

Another protocol for utilizing provision of nutritional supplement ofthe inventive concept with radiotherapy is shown in FIG. 18. A summaryof the treatment groups generated by the protocol shown in FIG. 18 isprovided in Table 5.

TABLE 5 Sacrifice (24^(th) day) 1 C Control N = 6 2 T Tumor N = 6 3 TNTumor + Nutritional Supplement N = 6 4 T3R Tumor + Radiotherapy (×3) N =6 5 T3RN Tumor + Radiotherapy (×3) + N = 6 Nutritional Supplement

In this protocol nutritional supplement of the inventive concept isprovided 7 days prior to implantation of tumor cells, with radiotherapytaking place on days 8, 10, and 12 following implantation. Mice weresacrificed on day 24 following implantation. Such a protocol was used toevaluate the effects of the nutritional supplement on a highlycharacteristic side effect of radiotherapy-weight loss. The effect ofnutritional supplement of the inventive concept on loss of body mass andin particular muscle mass following repeated radiotherapy is shown inFIGS. 19A and 19B. It should be appreciated that body mass wascharacterized following removal of the tumor mass. It is apparent thatpre-treatment with nutritional supplement of the inventive concepteffectively prevents the loss of body mass (relative to controlsubjects) resulting from repeated radiotherapy.

Another treatment protocol is shown in FIG. 20. A summary of thetreatment groups generated by the protocol shown in FIG. 20 is providedin Table 6.

TABLE 6 Sacrifice (21^(st) day) 1 C Control N = 6 2 T Tumor N = 6 3 PTNTumor + Nutritional Supplement (−7 day start) N = 6 4 TN Tumor +Nutritional Supplement (0 day start) N = 6 5 TR Tumor + Radiotherapy (3Gy × 3) N = 6 6 PTRN Tumor + Radiotherapy (3 Gy × 3) + N = 6 NutritionalSupplement (−7 day start) 7 TRN Tumor + Radiotherapy (3 Gy × 3) + N = 6Nutritional Supplement (8 day start)

In this protocol radiotherapy is provided on days 8, 10, and 12following implantation of tumor cells. Nutritional supplement of theinventive concept is provided either 7 days prior to implantation, theday of implantation, or on the first radiotherapy. Mice are sacrificedon day 21 following tumor cell implantation. This protocol was also usedto evaluate the effectiveness of the nutritional supplement on treatingradiotherapy-related weight loss. The effect of nutritional supplementof the inventive concept on loss of body mass and muscle mass whenprovided prior to and provided coincident with the initiation ofrepeated radiotherapy is shown in FIG. 21. It should be appreciated thatbody mass was characterized following removal of the tumor mass. It isapparent that pre-treatment with nutritional supplement of the inventiveconcept effectively reverses the loss of body mass (relative to controlsubjects) resulting from repeated radiotherapy.

Inventors have also found that pre-treatment with nutritional supplementof the inventive concept enhances the reduction in tumor volume seen onrepeated radiotherapy. Results of measurements of tumor volume duringtreatment of mice with the protocol shown in FIG. 20 are shown in FIG.22. As shown, treatment with the nutritional supplement is effective inreducing the increase in tumor volume over time, particularly incombination with radiotherapy.

The presence of tumors can also result in inflammation, which can becharacterized by the presence of pro-inflammatory cytokines in serum.FIGS. 23A and 23B show the effect of administration of nutritionalsupplement of the inventive concept with repeated radiotherapy on theconcentration of pro-inflammatory cytokines in mice treated as in theprotocol shown in FIG. 20. As shown, treatment with the nutritionalsupplement is effective in reducing the amount of pro-inflammatorycytokines found in serum of tumor-bearing animals, particularly incombination with radiotherapy.

While nutritional supplements of the inventive concept have been shownto be effective in enhancing the effects of radiotherapy and/or reducingthe side effects of radiotherapy, Inventors contemplate that similarbenefits are found when such nutritional supplements are used incombination with immunotherapies-particularly immunotherapies directedtowards the treatment of cancer. Such immunotherapy in combination withuse of a nutritional supplement of the inventive concept can be used incombination (e.g. either simultaneously or sequentially) with aradiotherapy.

It should be apparent to those skilled in the art that many moremodifications besides those already described are possible withoutdeparting from the inventive concepts herein. The inventive subjectmatter, therefore, is not to be restricted except in the spirit of theappended claims. Moreover, in interpreting both the specification andthe claims, all terms should be interpreted in the broadest possiblemanner consistent with the context. In particular, the terms “comprises”and “comprising” should be interpreted as referring to elements,components, or steps in a non-exclusive manner, indicating that thereferenced elements, components, or steps may be present, or utilized,or combined with other elements, components, or steps that are notexpressly referenced. Where the specification claims refer to at leastone of something selected from the group consisting of A, B, C . . . andN, the text should be interpreted as requiring only one element from thegroup, not A plus N, or B plus N, etc.

What is claimed is:
 1. A method of reducing growth of a cancer stemcell, comprising: identifying a patient in need of treatment for acancer comprising a cancer stem cell; and providing the patient with anamount of a nutritional supplement comprising selenium and fish oileffective to reduce growth of the cancer stem cell.
 2. The method ofclaim 1, wherein the nutritional supplement comprises selenium and fishoil in amounts as shown in Table
 1. 3. The method of claim 1, whereinthe nutritional supplement comprises Maltodextrin, Whey Protein Isolate,Whey Protein Concentrate, Fructooligosaccharides/Inulin, Oat Fiber, SoyProtein, Lecithin, Milk:Non-fat, Rice Protein Powder, Calcium Caseinate,Flax Seed Oil, Canola Oil, Borage Oil, Olive Oil, Lemon Oil, Orange Oil,Mixed Tocopherols, Potassium Phosphate, Calcium Carbonate, CholineBitartrate, Sodium Chloride, Calcium Phosphate, Ascorbic Acid, PotassiumChloride, Magnesium Oxide, Chromium Yeast, Molybdenum Yeast, Inositol,Zinc Sulfate, Vitamin E, Niacinamide, Ferric Orthophosphate, CalciumPantothenate, Manganese Sulfate, Beta Carotene, Copper Gluconate,Vitamin D3, Vitamin K2, Pyridoxine, Potassium Iodide, Riboflavin,Thiamine, Vitamin K1, Vitamin A, Folic Acid, d-Biotin, Vitamin B12,L-Carnitine, L-Glutamine, L-Arginine, Taurine, L-Lysine, Alpha LipoicAcid, Resveratrol, Co-Enzyme Q10, Glycine, Proline, Lact. Acidophilusculture, Bifido Bifidium culture, Lac. Bulgaricus culture, Bifido Longumculture, Strep. Thermophilus culture, Papain, Pepsin, Lipase, Bromelain,Pancreatin, Lactase, Betaine, Pineapple Juice Powder, Papaya FruitPowder, Quercetin, EGCG, OPC, Anthocyanins, Ellagic Acid, Astaxanthin,Cordyceps preparation, Ganoderma Lucidum preparation, Shiitakepreparation, Maitake preparation, and Turkey Tail preparation.
 4. Themethod of claim 3, wherein the nutritional supplement comprisesMaltodextrin, Whey Protein Isolate, Whey Protein Concentrate,Fructooligosaccharides/Inulin, Oat Fiber, Soy Protein, Lecithin,Milk:Non-fat, Rice Protein Powder, Calcium Caseinate, Flax Seed Oil,Canola Oil, Borage Oil, Olive Oil, Lemon Oil, Orange Oil, MixedTocopherols, Potassium Phosphate, Calcium Carbonate, Choline Bitartrate,Sodium Chloride, Calcium Phosphate, Ascorbic Acid, Potassium Chloride,Magnesium Oxide, Chromium Yeast, Molybdenum Yeast, Inositol, ZincSulfate, Vitamin E, Niacinamide, Ferric Orthophosphate, CalciumPantothenate, Manganese Sulfate, Beta Carotene, Copper Gluconate,Vitamin D3, Vitamin K2, Pyridoxine, Potassium Iodide, Riboflavin,Thiamine, Vitamin K1, Vitamin A, Folic Acid, d-Biotin, Vitamin B12,L-Carnitine, L-Glutamine, L-Arginine, Taurine, L-Lysine, Alpha LipoicAcid, Resveratrol, Co-Enzyme Q10, Glycine, Proline, Lact. Acidophilusculture, Bifido Bifidium culture, Lac. Bulgaricus culture, Bifido Longumculture, Strep. Thermophilus culture, Papain, Pepsin, Lipase, Bromelain,Pancreatin, Lactase, Betaine, Pineapple Juice Powder, Papaya FruitPowder, Quercetin, EGCG, OPC, Anthocyanins, Ellagic Acid, Astaxanthin,Cordyceps preparation, Ganoderma Lucidum preparation, Shiitakepreparation, Maitake preparation, and Turkey Tail preparation in amountsas shown in Table
 1. 5. The method of claim 1, wherein the nutritionalsupplement is provided concurrent with radiotherapy.
 6. The method ofclaim 1, wherein the nutritional supplement is provided to the patientduring the application of radiotherapy.
 7. The method of claim 1,wherein the nutritional supplement comprises one or more flavorantsselected from the group consisting of Brown Sugar, Honey, Natural FrenchVanilla Flavor, and Natural Vanilla Masking Flavor.